ESPN Thematic Report on Challenges in long-term care - Czech Republic (European Social Policy Network)
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| Year of publication | 2018 |
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| Description | The transformation of the Czech system of social services towards adequate access to services, deinstitutionalisation, sustainability and quality assurance has not been completed. In part, this is directly associated with issues surrounding long-term care (LTC) provision. The split between the health and social parts of it causes operational difficulties and inequalities, and sometimes raises concerns about the quality of care. The Czech Republic belongs to the traditional model, where LTC is largely considered a ‘family affair’, although there is no explicit legal or even constitutional obligation to care. Family members and friends provide most care. Institutional governance of LTC is a vertically fragmented, plural system, with competencies distributed between different institutional tiers: the state, the regions and municipalities. Significant regional differences in capacities – and consequently access to care – can be identified. Multi-source funding is a key concept of the funding scheme. Clients’ fees represent the main funding resource for social services – they account for nearly half of total costs. Other sources consist of the Ministry of Labour and Social Affairs (MLSA) subsidies and grants flowing into regional governments’ budgets. Health insurance funds are by far the most important resource for long-term health services – they cover almost all the costs. In 2015, total LTC expenditure was CZK 61.0 billion/EUR 2.39 billion (1.4% of GDP). A major reform step in the area of social services was accomplished in 2007. The new law on social services1 not only recognised a much broader range of social care services and institutions than before, but has also handed over a substantial share of public funds to the recipients of social services, in the form of care allowance. The allowance is scaled into four levels, according to the recipient’s degree of dependency on support. There was an implicit expectation that the recipients would decide for themselves on the most suitable way of acquiring social services and that their decisions would positively shape the network of formal providers of social services. These expectations have not been met fully. By introducing a new caregiver’s allowance in 2017, the government has demonstrated its awareness of the importance of informal care. It tries to improve the financial situation of family members who provide care for their dependent relatives, and it strengthens their position in the labour market. Demographic forecasts clearly suggest an increase in demand and need for care in future years. Between 2008 and 2067, the number of older seniors (aged 75 and over) will approximately treble, rising from 0.69 million to 2.02 million. Besides the financial sustainability of a system that relies significantly on public budgets, there are also concerns about the availability of human resources. The fact that the jobs are mostly poorly paid and demanding is the reason why the LTC system is already suffering a workforce shortage. The system faces several serious challenges. Access to some residential services is clearly inadequate. But the situation in the segment of non-resident, community-based or home care services is not satisfactory either. In some regions, there is an absence of support services for families caring for their members. The quality of care is difficult to assess – systematic monitoring is not conducted and the quality assurance system is far from perfect. Our policy recommendations deal mainly with areas of informal carer support, financial benefits for the most dependent persons, measures of financial stabilisation, quality assurance, and linking the social and health parts of LTC. |